Children with special needs such ADHD or autism spectrum disorder often are not in touch with long term contingencies.  Focusing the childs attention on long term contingencies can lead to big improvements in behavior and academic performance.  Some tips in focusing on the future are discussed below. When meeting with teachers it is helpful to focus on the potential of your child such as intelligence or social skills. Secondly, the parents can focus on the future by discussing the future with the child. For example, the parent might discuss what car, job, spouse, kids, money or job title they might want when they grow up. This should be done on a regular basis hopefull daily or weekly.  Thirdly, the parent might go onto the computer and look at people in jobs or careers the child might like, look at cars they might purchase or computer equipment.  Focussing on long term goals will focus their attention on the future. 

Clinicians are often presented with physical symptoms that suggest medical involvement during assessment or intake.  The first thing that therapist should consider doing is to recommend that the parent or caretaker immediately or as soon as possible follow-up on a medical issue. The medical issue should be ruled out and addressed by the parents in order to treat the client effectively with behavioral treatment.  Some examples of medical issues might be something as simple has hearing loss or ear infections. There is a large body of research and talks at conferences about the relationship between hearing or ear problems and diagnosis such as autism or other developmental delays or diagnosis. There is a large body of research regarding other medical problems such as blood pressure, diabetes or low blood sugar, constipation and the resulting behavior problems that may occur.  A thorough physical or a specialist such as an otologist may be a good recommendation. If there is a strong reason to believe that a general physical may not be sufficient then an expert in the problem such as an otologist or cardiologist might be something for the caregiver to consider in order to completely rule out the medical origin of the behavior.  However, even if there are medical causes of a behavior one can still treat the problem with non-restrictive behavioral procedures. Often the behavior problem has both medical and behavioral causes that are revealed in the functional assessment. Therefore both behavioral and medical treatment can work together to resolve the issues and the child can look forward to the possibility of achieving a normal life without behavior problems! 

Pshychotropic medication and behavior therapy work together and separately.  There are advantages to using behavior therapy in conjunction with medication.  The parent or client can gradually reduce the medication as the problem behavior becomes manageable or disappears. This is usually done with through the use of graphic displays of the progress/outcomes, data collection sheets, observation in different environments and analysis of the trends of the problem behavior compared to the medication changes. 

It should be noted that some problems do respond well to medication based on the research and some problems are merely improved by a sedation of all behavior. One might consider researching the medication to affirm that there is some validated benefit before using it for yourself or  a child. It is helpful to note exactly when the changes are made in the clients medication so that it can be determined whether any benefit is  derived from the medication. Discussion about reduction or changes should be brought up at each meeting with the doctor prescribing the medication. It is useful to bring a graph of the behavior and general procedures used so that the doctor understands all variable affecting the progress of the clients behavior. For example, if a new program procedure started last month and the behavior decreased dramatically then a reduction in the medication might be discussed and considered. Generally, the doctor usually reduces the medication slowly so that there are no side-effects.  Generally, taking medication for long periods of time or even short time periods can cause serious and mild side effects and this should be considered in deciding whether to use medications.  It should be noted that each individual case is  deferent and other factors in the environment or health factors also effect the behavior of the client. Individual differences and specific graphs or data should be used as tools in making decisions about whether to take medication, reduce medication or change medications.